There are currently, numerous techniques and fixation methods for hamstring anterior cruciate ligament (ACL) reconstructions. The majority of techniques for hamstring fixation involve either an interference type device (such as an interference screw) which relies on interference fixation against the graft; or a suspensory type of device (such as EndoButton, Retrobutton, or transfix) which relies on fixation at a distal point away from the graft. Problems that arise from interference fixation include weaker fixation and iatrogenic damage to the graft. This results from the fact that fixation is achieved by interference fit of the screw against the graft within a tunnel/socket. The interference screw cannot be so tight that it amputates the graft but cannot be so loose that there is no interference fixation. Problems that arise from distal fixation include tunnel widening and osteolysis. Distal fixation devices sit on the far cortex and as a result of micro motion cause osteolysis and a phenomenon of “tunnel widening.”
A hybrid technique involves the use of a suspension type device (such as woven flat tape) with interference fixation of the woven flat tape with an interference screw on the far cortex. The problem with this particular hybrid technique is that potential risk exists for slippage of the tape against the interference screw and ultimate fixation failure.